{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T04:08:42Z","timestamp":1793074122006,"version":"4.5.0"},"reference-count":52,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2021,9,9]],"date-time":"2021-09-09T00:00:00Z","timestamp":1631145600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1041897"],"award-info":[{"award-number":["1041897"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Mason Foundation National Medical Program","id":[{"id":"https:\/\/ror.org\/02z8wa502","id-type":"ROR","asserted-by":"crossref"}]},{"name":"NIHR Biomedical Research Centre at South London"},{"name":"Maudsley NHS Foundation Trust and King\u2019s College London","id":[{"id":"https:\/\/ror.org\/0220mzb33","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Fatigue is a dominant feature of both acute and convalescent coronavirus disease 2019 (COVID-19) (sometimes termed \u201clong-COVID\u201d), with up to 46% of patients reporting fatigue that lasts from weeks to months. The investigators of the international Collaborative on Fatigue Following Infection (COFFI) conducted a systematic review of post-COVID fatigue and a narrative review on fatigue after other infections, and made recommendations for clinical and research approaches to assessing fatigue after COVID-19.<\/jats:p>\n                  <jats:p>In the majority of COVID-19 cohort studies, persistent fatigue was reported by a significant minority of patients, ranging from 13% to 33% at 16\u201320 weeks post-symptom onset. Data from the prospective cohort studies in COFFI and others indicate that fatigue is also a prevalent outcome from many acute systemic infections, notably infectious mononucleosis, with a case rate for clinically significant Post-infective fatigue after exclusion of recognized medical and psychiatric causes, ranging from 10%\u201335% at 6 months.<\/jats:p>\n                  <jats:p>To better characterize post-COVID fatigue, the COFFI investigators recommend the following: application of validated screening questionnaires for case detection; standardized interviews encompassing fatigue, mood, and other symptoms; and investigative approaches to identify end-organ damage and mental health conditions.<\/jats:p>","DOI":"10.1093\/ofid\/ofab440","type":"journal-article","created":{"date-parts":[[2021,9,9]],"date-time":"2021-09-09T06:55:15Z","timestamp":1631170515000},"source":"Crossref","is-referenced-by-count":213,"title":["Long COVID and Post-infective Fatigue Syndrome: A Review"],"prefix":"10.1093","volume":"8","author":[{"given":"Carolina X","family":"Sandler","sequence":"first","affiliation":[{"name":"The Kirby Institute, UNSW Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vegard B B","family":"Wyller","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine, Akershus University Hospital, L\u00f8renskog, Norway"},{"name":"Institute of Clinical Medicine, University of Oslo, Blindern, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rona","family":"Moss-Morris","sequence":"additional","affiliation":[{"name":"Health Psychology, Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dedra","family":"Buchwald","sequence":"additional","affiliation":[{"name":"Institute for Research and Education to Advance Community Health, Washington State University, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"Crawley","sequence":"additional","affiliation":[{"name":"Bristol Medical School, University of Bristol. Bristol. Centre for Academic Child Health, Bristol, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeannine","family":"Hautvast","sequence":"additional","affiliation":[{"name":"Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Nijmegen, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben Z","family":"Katz","sequence":"additional","affiliation":[{"name":"Northwestern University Feinberg School of Medicine, Chicago, Department of Pediatrics, Chicago, Illinois, USA"},{"name":"Ann & Robert H Lurie Children\u2019s Hospital of Chicago, Division of Infectious Diseases, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Knoop","sequence":"additional","affiliation":[{"name":"Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Little","sequence":"additional","affiliation":[{"name":"Primary Care Research Centre, Primary Care Public Health and Medical Education Unit, Faculty of Medicine, University of Southampton, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renee","family":"Taylor","sequence":"additional","affiliation":[{"name":"College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Knut-Arne","family":"Wensaas","sequence":"additional","affiliation":[{"name":"Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6277-8887","authenticated-orcid":false,"given":"Andrew R","family":"Lloyd","sequence":"additional","affiliation":[{"name":"The Kirby Institute, UNSW Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,9,9]]},"reference":[{"key":"2021100717173377800_CIT0001","first-page":"; 93:2555\u20136","article-title":"Chronic COVID syndrome: need for an appropriate","author":"Baig","year":"2020","journal-title":"J Med Virol"},{"key":"2021100717173377800_CIT0002","author":"Time."},{"key":"2021100717173377800_CIT0003","doi-asserted-by":"crossref","first-page":"2240","DOI":"10.1093\/brain\/awx153","article-title":"The fatigue conundrum","volume":"140","author":"Kuppuswamy","year":"2017","journal-title":"Brain"},{"key":"2021100717173377800_CIT0004","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1017\/S0033291701003841","article-title":"Acute sickness behaviour: an immune system-to-brain communication?","volume":"31","author":"Vollmer-Conna","year":"2001","journal-title":"Psychol Med"},{"key":"2021100717173377800_CIT0005","first-page":"106","article-title":"The international Collaborative on Fatigue Following Infection (COFFI)","volume":"6","author":"Katz","year":"2018","journal-title":"Fatigue"},{"key":"2021100717173377800_CIT0006","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1097\/PSY.0000000000000061","article-title":"Characterization of fatigue states in medicine and psychiatry by structured interview","volume":"76","author":"Bennett","year":"2014","journal-title":"Psychosom Med"},{"key":"2021100717173377800_CIT0007","doi-asserted-by":"crossref","first-page":"953","DOI":"10.7326\/0003-4819-121-12-199412150-00009","article-title":"The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group","volume":"121","author":"Fukuda","year":"1994","journal-title":"Ann Intern Med"},{"key":"2021100717173377800_CIT0008","doi-asserted-by":"crossref","first-page":"e0239235","DOI":"10.1371\/journal.pone.0239235","article-title":"Clinical, laboratory and radiological characteristics and outcomes of novel coronavirus (SARS-CoV-2) infection in humans: a systematic review and series of meta-analyses","volume":"15","author":"Borges do Nascimento","year":"2020","journal-title":"PLoS One"},{"key":"2021100717173377800_CIT0009","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/j.cmi.2020.09.052","article-title":"Follow-up of adults with noncritical COVID-19 two months after symptom onset","volume":"27","author":"Carvalho-Schneider","year":"2021","journal-title":"Clin Microbiol Infect"},{"key":"2021100717173377800_CIT0010","first-page":"; 27:626\u201331","article-title":"Attributes and predictors of long COVID","author":"Sudre","year":"2021","journal-title":"Nat Med"},{"key":"2021100717173377800_CIT0011","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1093\/qjmed\/hcaa178","article-title":"Clinical features and outcomes of discharged coronavirus disease 2019 patients: a prospective cohort study","volume":"113","author":"Wang","year":"2020","journal-title":"QJM"},{"key":"2021100717173377800_CIT0012","article-title":"Patient outcomes after hospitalisation with COVID-19 and implications for follow-up: results from a prospective UK cohort","author":"Arnold","year":"2020","journal-title":"Thorax"},{"key":"2021100717173377800_CIT0013","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1001\/jama.2020.12603","article-title":"Persistent symptoms in patients after acute COVID-19","volume":"324","author":"Carf\u00ec","year":"2020","journal-title":"JAMA"},{"key":"2021100717173377800_CIT0014","doi-asserted-by":"crossref","first-page":"e4","DOI":"10.1016\/j.jinf.2020.08.029","article-title":"Post-discharge persistent symptoms and health-related quality of life after hospitalization for COVID-19","volume":"81","author":"Garrigues","year":"2020","journal-title":"J Infect"},{"key":"2021100717173377800_CIT0015","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1002\/jmv.26368","article-title":"Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: a cross-sectional evaluation","volume":"93","author":"Halpin","year":"2021","journal-title":"J Med Virol"},{"key":"2021100717173377800_CIT0016","doi-asserted-by":"crossref","first-page":"ofaa507","DOI":"10.1093\/ofid\/ofaa507","article-title":"Prolonged and late-onset symptoms of coronavirus disease 2019","volume":"7","author":"Miyazato","year":"2020","journal-title":"Open Forum Infect Dis"},{"key":"2021100717173377800_CIT0017","article-title":"Psychological morbidities and fatigue in patients with confirmed COVID-19 during disease outbreak: prevalence and associated biopsychosocial risk factors","author":"Qi","year":"2020","journal-title":"Preprint. medRxiv. 2020;2020.05.08.20031666. Published May 11"},{"key":"2021100717173377800_CIT0018","first-page":".10.16.20211029;","article-title":"Three-month outcomes in hospitalized COVID-19 patients [preprint","author":"Savarraj","year":"2020","journal-title":"medRxiv"},{"key":"2021100717173377800_CIT0019","doi-asserted-by":"crossref","first-page":"e0240784","DOI":"10.1371\/journal.pone.0240784","article-title":"Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection","volume":"15","author":"Townsend","year":"2020","journal-title":"PLoS One"},{"key":"2021100717173377800_CIT0020","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.cmi.2020.09.023","article-title":"Clinical sequelae of COVID-19 survivors in Wuhan, China: a single-centre longitudinal study","volume":"27","author":"Xiong","year":"2021","journal-title":"Clin Microbiol Infect"},{"key":"2021100717173377800_CIT0021","doi-asserted-by":"crossref","first-page":"106197","DOI":"10.1016\/j.rmed.2020.106197","article-title":"Follow up of patients with severe coronavirus disease 2019 (COVID-19): pulmonary and extrapulmonary disease sequelae","volume":"174","author":"Daher","year":"2020","journal-title":"Respir Med"},{"key":"2021100717173377800_CIT0022","first-page":"; 214:279\u201380","article-title":"High rate of persistent symptoms up to 4 months after community and hospital-managed SARS-CoV-2 infection","author":"Darley","year":"2020","journal-title":"Med J Aust"},{"key":"2021100717173377800_CIT0023","doi-asserted-by":"crossref","first-page":"e0243882","DOI":"10.1371\/journal.pone.0243882","article-title":"Persistence of symptoms and quality of life at 35 days after hospitalization for COVID-19 infection","volume":"15","author":"Jacobs","year":"2020","journal-title":"PLoS One"},{"key":"2021100717173377800_CIT0024","doi-asserted-by":"crossref","first-page":"e13746","DOI":"10.1111\/ijcp.13746","article-title":"Assessment and characterisation of post-COVID-19 manifestations","volume":"75","author":"Kamal","year":"2021","journal-title":"Int J Clin Pract"},{"key":"2021100717173377800_CIT0025","doi-asserted-by":"crossref","first-page":"e418","DOI":"10.3346\/jkms.2020.35.e418","article-title":"Three-month follow-up study of survivors of Coronavirus disease 2019 after discharge","volume":"35","author":"Liang","year":"2020","journal-title":"J Korean Med Sci"},{"key":"2021100717173377800_CIT0026","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1136\/thoraxjnl-2020-215818","article-title":"\u2018Long-COVID\u2019: a cross-sectional study of persisting symptoms, biomarker and imaging abnormalities following hospitalisation for COVID-19","volume":"76","author":"Mandal","year":"2021","journal-title":"Thorax"},{"key":"2021100717173377800_CIT0027","article-title":"Long","author":"Petersen","year":"2020","journal-title":"Clin Infect Dis"},{"key":"2021100717173377800_CIT0028","doi-asserted-by":"crossref","first-page":"e0241537","DOI":"10.1371\/journal.pone.0241537","article-title":"A one-year hospital-based prospective COVID-19 open-cohort in the Eastern Mediterranean region: the Khorshid COVID Cohort (KCC) study","volume":"15","author":"Sami","year":"2020","journal-title":"PLoS One"},{"key":"2021100717173377800_CIT0029","first-page":":1\u20135","article-title":"Long-term neurological manifestations of COVID-19: prevalence and predictive factors","author":"Pilotto","year":"2021","journal-title":"Neurol Sci"},{"key":"2021100717173377800_CIT0030","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1136\/jech.2003.008466","article-title":"Bias","volume":"58","author":"Delgado-Rodr\u00edguez","year":"2004","journal-title":"J Epidemiol Community Health"},{"key":"2021100717173377800_CIT0031","doi-asserted-by":"crossref","first-page":"152","DOI":"10.3389\/fpubh.2020.00152","article-title":"Gender differences in patients with COVID-19: focus on severity and mortality","volume":"8","author":"Jin","year":"2020","journal-title":"Front Public Health"},{"key":"2021100717173377800_CIT0032","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1016\/S2215-0366(21)00084-5","article-title":"6-month neurological and psychiatric outcomes in 236\u2009379 survivors of COVID-19: a retrospective cohort study using electronic health records","volume":"8","author":"Taquet","year":"2021","journal-title":"Lancet Psychiatry"},{"key":"2021100717173377800_CIT0033","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1038\/s41586-021-03553-9","article-title":"High-dimensional characterization of post-acute sequelae of COVID-19","volume":"594","author":"Al-Aly","year":"2021","journal-title":"Nature"},{"key":"2021100717173377800_CIT0034","doi-asserted-by":"crossref","first-page":"2759","DOI":"10.1001\/archinte.1993.00410240067007","article-title":"Prevalence of fatigue and chronic fatigue syndrome in a primary care practice","volume":"153","author":"Bates","year":"1993","journal-title":"Arch Intern Med"},{"key":"2021100717173377800_CIT0035","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1016\/S0140-6736(95)92537-6","article-title":"Postinfectious fatigue: prospective cohort study in primary care","volume":"345","author":"Wessely","year":"1995","journal-title":"Lancet"},{"key":"2021100717173377800_CIT0036","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.jpsychores.2017.06.013","article-title":"Biopsychosocial risk factors of persistent fatigue after acute infection: a systematic review to inform interventions","volume":"99","author":"Hulme","year":"2017","journal-title":"J Psychosom Res"},{"key":"2021100717173377800_CIT0037","doi-asserted-by":"crossref","DOI":"10.1093\/cid\/ciaa1886","article-title":"Risks for developing ME\/CFS in college students following infectious mononucleosis: a prospective cohort study","author":"Jason","year":"2020","journal-title":"Clin Infect Dis"},{"key":"2021100717173377800_CIT0038","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1093\/qjmed\/hcw041","article-title":"The natural history of acute Q fever: a prospective Australian cohort","volume":"109","author":"Hopper","year":"2016","journal-title":"QJM"},{"key":"2021100717173377800_CIT0039","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1086\/500248","article-title":"Prolonged illness after infectious mononucleosis is associated with altered immunity but not with increased viral load","volume":"193","author":"Cameron","year":"2006","journal-title":"J Infect Dis"},{"key":"2021100717173377800_CIT0040","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1186\/1479-5876-10-191","article-title":"Cytokine expression profiles of immune imbalance in post-mononucleosis chronic fatigue","volume":"10","author":"Broderick","year":"2012","journal-title":"J Transl Med"},{"key":"2021100717173377800_CIT0041","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s12865-017-0190-3","article-title":"Giardia-specific cellular immune responses in post-giardiasis chronic fatigue syndrome","volume":"18","author":"Hanevik","year":"2017","journal-title":"BMC Immunol"},{"key":"2021100717173377800_CIT0042","doi-asserted-by":"crossref","first-page":"1684","DOI":"10.1002\/jmv.21873","article-title":"Serological and virological investigation of the role of the herpesviruses EBV, CMV and HHV-6 in post-infective fatigue syndrome","volume":"82","author":"Cameron","year":"2010","journal-title":"J Med Virol"},{"key":"2021100717173377800_CIT0043","author":"National Institute for Health and Care Excellence."},{"key":"2021100717173377800_CIT0044","doi-asserted-by":"crossref","DOI":"10.3399\/bjgpopen20X101143","article-title":"Finding the \u2018right\u2019 GP: a qualitative study of the experiences of people with long-COVID","volume":"4","author":"Kingstone","year":"2020","journal-title":"BJGP Open"},{"key":"2021100717173377800_CIT0045","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1016\/j.bbi.2011.12.009","article-title":"Genetic associations of fatigue and other symptom domains of the acute sickness response to infection","volume":"26","author":"Piraino","year":"2012","journal-title":"Brain Behav Immun"},{"key":"2021100717173377800_CIT0046","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.bbi.2019.07.034","article-title":"Contribution of individual psychological and psychosocial factors to symptom severity and time-to-recovery after naturally-occurring acute infective illness: the Dubbo Infection Outcomes Study (DIOS)","volume":"82","author":"Cvejic","year":"2019","journal-title":"Brain Behav Immun"},{"key":"2021100717173377800_CIT0047","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1097\/00006842-199905000-00009","article-title":"Critical life events, infections, and symptoms during the year preceding chronic fatigue syndrome (CFS): an examination of CFS patients and subjects with a nonspecific life crisis","volume":"61","author":"Theorell","year":"1999","journal-title":"Psychosom Med"},{"key":"2021100717173377800_CIT0048","doi-asserted-by":"crossref","first-page":"719","DOI":"10.5664\/jcsm.2276","article-title":"Sleep abnormalities in chronic fatigue syndrome\/myalgic encephalomyelitis: a review","volume":"8","author":"Jackson","year":"2012","journal-title":"J Clin Sleep Med"},{"key":"2021100717173377800_CIT0049","doi-asserted-by":"crossref","first-page":"e17600","DOI":"10.1097\/MD.0000000000017600","article-title":"Evidence of altered cardiac autonomic regulation in myalgic encephalomyelitis\/chronic fatigue syndrome: a systematic review and meta-analysis","volume":"98","author":"Nelson","year":"2019","journal-title":"Medicine (Baltimore)"},{"key":"2021100717173377800_CIT0050","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1038\/nrendo.2011.153","article-title":"Hypothalamic-pituitary-adrenal axis dysfunction in chronic fatigue syndrome","volume":"8","author":"Papadopoulos","year":"2011","journal-title":"Nat Rev Endocrinol"},{"key":"2021100717173377800_CIT0051","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1176\/appi.ajp.160.2.221","article-title":"Chronic fatigue syndrome: a review","volume":"160","author":"Afari","year":"2003","journal-title":"Am J Psychiatry"},{"key":"2021100717173377800_CIT0052","doi-asserted-by":"crossref","first-page":"110154","DOI":"10.1016\/j.jpsychores.2020.110154","article-title":"Patterns of daytime physical activity in patients with chronic fatigue syndrome","volume":"135","author":"King","year":"2020","journal-title":"J Psychosom Res"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ofid\/advance-article-pdf\/doi\/10.1093\/ofid\/ofab440\/40340144\/ofab440.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ofid\/article-pdf\/8\/10\/ofab440\/40526010\/ofab440.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ofid\/article-pdf\/8\/10\/ofab440\/40526010\/ofab440.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,10]],"date-time":"2021-10-10T15:49:12Z","timestamp":1633880952000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofab440\/6367589"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,9]]},"references-count":52,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2021,10,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofab440","relation":{},"ISSN":["2328-8957"],"issn-type":[{"value":"2328-8957","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,10,1]]},"published":{"date-parts":[[2021,9,9]]},"article-number":"ofab440"}}